title: Patient volume, human resource levels, and attrition from HIV treatment programs in central Mozambique.
abstract: BACKGROUND
  Human resource shortages are viewed as one of the primary obstacles to provide effective services to growing patient populations receiving antiretroviral therapy (ART) and to expand ART access further. We examined the relationship of patient volume, human resource levels, and patient characteristics with attrition from HIV treatment programs in central Mozambique.
  
  
  METHODS
  We conducted a retrospective cohort study of adult, ART-naive, nonpregnant patients who initiated ART between January 2006 and June 2008 in the national HIV care program. Cox proportional hazards models were used to assess the association of patient volume, clinical staff burden, and pharmacy staff burden with attrition, adjusting for patient characteristics.
  
  
  RESULTS
  A total of 11,793 patients from 18 clinics were studied. After adjusting for patient characteristics, patients attending clinics with medium pharmacy staff burden [hazard ratio (HR) = 1.39 (95% CI: 1.07 to 1.80)] and high pharmacy staff burden [HR = 2.09 (95% CI: 1.50 to 2.91)] tended to have a higher risk of attrition (P value for trend: <0.001). Patients attending clinics with higher clinical staff burden did not have a statistically higher risk of attrition. Patients attending clinics with medium patient volume levels [HR = 1.45 (95% CI: 1.04 to 2.04)] and high patient volume levels [HR = 1.41 (95% CI: 1.04 to 1.92)] had a higher risk of attrition, but the trend test was not significant (P = 0.198).
  
  
  CONCLUSIONS
  Patients attending clinics with higher pharmacy staff burden had a higher risk of attrition. These results highlight a potential area within the health system where interventions could be applied to improve the retention of these patient populations.
authors.affiliation: Pangaea Global AIDS Foundation, Oakland, CA, USA. blambdin@pgaf.org
authors.forename: Barrot H
authors.initials: BH
authors.lastname: Lambdin
authors.forename: Mark A
authors.initials: MA
authors.lastname: Micek
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: James P
authors.initials: JP
authors.lastname: Hughes
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sherr
authors.forename: James
authors.initials: J
authors.lastname: Pfeiffer
authors.forename: Marina
authors.initials: M
authors.lastname: Karagianis
authors.forename: Joseph
authors.initials: J
authors.lastname: Lara
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Gloyd
authors.forename: Andy
authors.initials: A
authors.lastname: Stergachis
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003157:Community Pharmacy Services / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006280:Health Workforce / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents